Years ago, William Cooke sensed a crisis building. The only doctor in rural Austin, Indiana, noticed that intravenous drug use was soaring in his town of roughly 4,300, where 23 percent of residents live below the poverty line. He feared that people addicted to injectable painkillers might be plucking used needles off lawns, shooting up — and passing them on. A surge of drug overdoses hit Cooke's family practice, where he'd treat anyone with $10. More hepatitis C infections followed. Next came an HIV diagnosis in December, rare in southeastern Scott County. By Friday, the number of new cases had climbed toward 80. Last week, Indiana Gov. Mike Pence declared the outbreak a...

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